title: Midwives' views on appropriate antenatal counselling for congenital anomaly tests: do they match clients' preferences?
abstract: OBJECTIVE
  this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling.
  
  
  METHODS
  a comparative (midwives versus clients) questionnaire survey. Cognitive interviews (n=8) were used to validate the internal validity of the midwifery questionnaire results.
  
  
  METHODS
  1416 Dutch midwives (response 62%) completed a questionnaire measuring their views on appropriate antenatal counselling for congenital anomaly tests.
  
  
  METHODS
  we used the 58-item midwives' version of the QUOTE (prenatal), an instrument to assess clients' counselling preferences. Descriptive statistics were used to explore midwives' views on appropriate counselling and how these relate to client preferences as measured previously with the clients' version of the QUOTE (prenatal).
  
  
  RESULTS
  almost all midwives consider the client-midwife relation (100%) and health education (95%) to be (very) important for appropriate antenatal counselling for congenital anomaly tests. Almost half of the midwives consider decision-making support (47%) to be (very) important. These findings are practically congruent with client preferences. Still, clinically relevant differences were found regarding 13 individual items, e.g. more clients than midwives value 'medical information about congenital anomalies' and 'getting advice whether to take prenatal tests or not'.
  
  
  CONCLUSIONS
  like clients, most midwives value a good client-midwife relation and health education as (very) important for antenatal counselling for congenital anomaly tests. Less than half of them value decision-making support. These findings are in contrast with the literature in which decision-making support is seen as the most important part of antenatal counselling for congenital anomaly tests.
  
  
  CONCLUSIONS
  preferably, antenatal counselling for congenital anomaly tests should be consistent with the three-function model of antenatal counselling i.e. maintaining a client-midwife relation, providing health education as well as decision-making support, and tailored to clients' individual preferences. As not all midwives subscribe to these functions, reflection on their views is important. Furthermore, midwives need to bridge their views on appropriate antenatal counselling and client preferences. To do so, midwives may benefit from the Shared Decision Making approach.
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: linda.martin@INHOLLAND.nl.
authors.forename: Linda
authors.initials: L
authors.lastname: Martin
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Obstetrics & Gynecology, Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada. Electronic address: huttone@mcmaster.ca.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: evelienspelten@yahoo.com.
authors.forename: Evelien R
authors.initials: ER
authors.lastname: Spelten
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Faculty of Theology, VU University, Amsterdam, The Netherlands. Electronic address: Jt.vanderwal@vumc.nl.
authors.forename: Janneke T
authors.initials: JT
authors.lastname: Gitsels-van der Wal
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Health Sciences, Buskerud University College, Drammen, Norway. Electronic address: S.vanDulmen@nivel.nl.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000451:nursing; D003430:Cross-Sectional Studies; D003657:Decision Making; D003718:Denmark; D005260:Female; D005817:Genetic Counseling / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D008880:Midwifery; D057240:Patient Preference; D011247:Pregnancy; D011795:Surveys and Questionnaires; D016216:Ultrasonography, Prenatal
keywords: Antenatal counselling; Congenital anomalies; Midwives; Professional opinions